Got a minute?
Will you kindly take a few minutes to tell me more about you and your preferences
What is your gender?
Male
Non-binary
Prefer not to answer
What is your age range?
0-17
18-29
60-69
30-39
70 or better
40-49
What area of your health needs your focus most?
Breaking patterns. (self-sabotage, impulsive eating, overeating etc.)
Mental/emotional/spiritual health related to food and eating.
I need a road-map to lose weight and don’t know where to start.
I know what I need to do and don’t trust myself, I just need a coach and accountability.
Knowing exactly what I should eat.
What do you want to know more of regarding your health and wellness?
I want to learn more about how to help my gut.
I want to be less moody and anxious.
I want to lose weight by going on a diet plan.
I want to create more self-love and pleasure around food and eating
I want to learn to break behavioral patterns that weren’t serving me. ( ex. emotional eating)
Other
How committed are you to change?
I am completely happy with the status quo and things can stay as they are.
I want to take action, but I am not willing to do what it takes to invest.
I don’t care enough to change myself.
I definitely want to change, and ready to commit to myself. Let’s GO!
Everyone thinks I should, but I am not so sure that I can.
I’m contemplating the next step.
What is the one thing holding you back?
I feel like I don’t have time.
I don’t know what it takes to invest in myself.
I lack family or friend support.
I feel like I’m too busy.
I struggle with self worth.
Nothing.
How important is cooking and eating homemade food in your household?
I don’t like to or want to.
I want to but I feel like I don’t have a lot of time so I eat out and, or order take-out.
I don’t have the energy to cook so I eat out and, or order take-out.
I don’t know anything about cooking and I would like to know more.
I love cooking and enjoy learning about healthy options.
Other
What is your favorite way to receive support and guidance?
One on one, in person.
One on one, on-line.
In-person group connection.
On-line, group retreat.
Videos and written material (on-line pre-recorded material).
What would be important for me to know about you that is not covered in the survey?
I can’t seem to pick an answer for most of the questions. Please advise.
Will you please share your phone number?
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